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Ch 12 Personality Disorder.docx

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PSY 325
Stephanie Cassin

Chapter 12: Personality Disorders Personality: ways we have of acting, thinking, believing, feeling that makes us unique Personality trait: complex pattern of behaviour, thought, feeling that is stable across time & situations Defining & Diagnosing Personality Disorders  Personality disorder: long-standing pattern of maladaptive behaviours, thoughts, & feelings  Symptoms shown since adolescence or early adulthood for diagnosis  Axis II of DSM-IV-TR  Cluster A: odd eccentric personality disorders o Similar to those with schizophrenia: flat/inappropriate affect, odd thought & speech patterns, paranoia o Maintains grasp on reality (not psychotic) o Paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder  Cluster B: dramatic-erratic personality disorder o Dramatic, erratic, emotional o Manipulative, volatile, uncaring in social relationships o Impulsive, sometimes violent showing little regard for own/other’s safety (suicidal attempts to gain attention) o Antisocial, histrionic, borderline, narcissistic personality disorders  Cluster C: anxious-fearful personality disorder o Super concerned about being criticized or abandoned by others thus have dysfunctional relationship with others o Dependent, avoidant, obsessive-compulsive personality disorder Problems with the DSM Categories  Treats these disorders as categories but they’re extremes of “normal personalities” – lots of common underlying traits  Lots of overlap in diagnostic criteria – suggests fewer personality disorders that can account for variability in symptoms, difficult to obtain reliable diagnosis  Diagnosing requires information that is hard to obtain – reliability issues with observation of traits & symptoms  Personality disorders conceptualized as stable characteristics of an individual however frequency & severity of symptoms vary Gender & Ethnic Biases in Construction & Application  Histrionic, dependent, borderline personality disorders = flamboyant behaviour, emotionality, dependence on others argued to be extreme versions of negative stereotypes of women’s personalities therefore clinicians are too quick to apply these diagnosis to women clients  Antisocial, paranoid, obsessive-compulsive personality disorders = violent, hostile, controlling behaviour argued to be extreme versions of negative stereotypes of men  Doesn’t recognize that symptoms can vary across groups e.g. women with antisocial disorder less likely to overtly display symptoms like acts of cruelty in public; certain ethnic groups might better hide their behaviour  Argued that it ignores/downplays possible masculine ways of expression dependent, histrionic, borderline personality disorders (in bias wording & application) o Use structure interviews in assessing personality disorders instead of unstructured interviews – less gender bias (although it still exists) o Greater numbers of women diagnosed with histrionic, dependent, & borderline o Greater numbers of men diagnosed with antisocial personality disorder ODD-ECCENTRIC PERSONALITY DISORDER  Behave similar to those with schizophrenia/paranoid psychotic disorder but retain their grasp on reality to a greater degree  Be paranoid, speak in odd/eccentric ways, difficulty relating to other people, have unusual beliefs 1. Paranoid Personality Disorder  Key features: chronic & pervasive mistrust & suspicion of other people that is unwarranted & maladaptive  Weak relationship with schizophrenia  Great observers of situations, noting details most people would miss  Overly sensitive to criticism or potential criticism  Tend to misinterpret/overinterpret situations in line with their suspicions  E.g. think arguing with them as evidence that the person is part of the conspiracy against them  Some withdraw to protect themselves  Some are aggressive & arrogant, think their way of looking at the world is right & superior Prevalence & Prognosis of Paranoid Personality Disorder  More males treated for paranoid personality disorder than females  People diagnosed at risk for acute physiological problems: major depression, anxiety disorders, substance abuse, psychotic episodes  Unstable interpersonal relationships Theories & Treatment of Paranoid Personality Disorder  Somewhat more common in families of people with schizophrenia  Cognitive theorists: result of underlying belief that other people are malevolent & deceptive + lack of self confidence about being able to defend oneself against others o Must always be on the look out & ready to act out against others  Usually go to clinician for acute problems like depression & do not feel the need to be treated for their paranoia  Therapist must be calm, respectful, extremely straightforward to gain trust of person with paranoid personality disorder o Must be highly professional at all times – do not attempt to be warm, personal – will be misinterpreted o Must confront client indirectly about paranoid thinking – redefine the situation from a different perspective  Cognitive therapy: increase sense of self-efficacy for dealing with difficult situations = decrease their fear & hostility toward others 2. Schizoid Personality Disorder  Key features: chronic lack of interest in & avoidance of interpersonal relationships, emotional coldness toward others  Unclear relationship with schizophrenia  Described as aloof, reclusive, detached, dull, uninteresting, humourless  Show little emotion in interpersonal interactions  View relationships with others as unrewarding, messy, intrusive Prevalence of Schizoid Personality Disorder  Very rare  More males seek treatment than females (3:1) particularly in occupations that don’t require interpersonal interactions Theories & Treatment of Schizoid Personality Disorder  Slightly increased rate for those with relatives with schizophrenia  May be partially inherited  Possible antecedents: insecure attachment patterns – compulsive self-reliance  Psychosocial therapy: increase person’s social skills, social contacts, awareness of his/her own feelings o Therapist may model expression of feelings for client & help them id their own feelings  Cognitive therapy: social skills training done through role play to try out new social skills with other people o Group therapy recommended 3. Schizotypal Personality Disorder  Key features: chronic pattern of inhibited or inappropriate emotion & social behaviour, aberrant cognitions, disorganized speech – have restricted range of emotions, socially isolated, uncomfortable in social interactions  Strong relationship – considered a mild version of schizophrenia  As children: passive, socially unengaged, hypersensitive to criticism  4 categories of oddities in cognition 1. Paranoia & suspiciousness: anxiety arises from paranoia, people are deceitful 2. Ideas of reference: believe random events/circumstances are related to them 3. Odd beliefs & magical thinking: e.g. believe others know what they are thinking 4. Illusions: almost like hallucinations e.g. see people in patterns of wallpaper  Speech is: tangential, circumstantial, vague, overelaborate  Social interactions: inappropriate or no emotional response to what other people say or do  Odd behaviours: easily distracted or fixated  On neuropsychological tests: deficits in working memory, learning, recall (similar to those with schizophrenia) o Not as severe as schizophrenia & maintain basic contact with reality Prevalence of Schizotypal Personality Disorder  Twice as commonly diagnosed in males than females  At risk for depression, schizophrenia, or isolated psychotic episodes  Odd/eccentric thoughts cannot be part of cultural beliefs for diagnosis  Biological vulnerability to schizophrenia-like disorders: perinatal brain damage, urban living, low socioeconomic status Theories & Treatment of Schizotypal Personality Disorder  Family history, adoption, twin studies  strong genetic link  Mild form of schizophrenia, also transmitted in similar ways  Problems in ability to sustain attention on cognitive tasks, deficits in memory  Dysregulation of dopamine (abnormally high dopamine levels)  Similar structure abnormalities like those with schizophrenia  Treated with similar drugs used to treat schizophrenia: neuroleptics (halodoperidol, thiothixene), atypical antipsychotics (olanzapine) o Relieves psychotic-like symptoms: ideas of reference, magical thinking, illusions  Antidepressants for those expressing significant distress  Psychological therapy: important for therapist to establish good relationship with client since they usually have few close relationships, tend to be paranoid o Increase social contacts, learn socially appropriate behaviours through social skills training o Group therapy for social skills training  Cognitive therapy: teach them to look for objective evidence in environment for their thoughts & to disregard bizarre thoughts DRAMATIC-ERRATIC PERSONALITY DISORDERS  Often show little regard to own & others’ safety  Suicidal, self damaging (cutting), hostile, violent  Core feature: lack of concern for others 1. Antisocial Personality Disorder (ASPD)  Key features: pervasive pattern of criminal, impulsive, callous, or ruthless behaviour; disregard for the rights of others no respect for social norms, inability to form positive relationships with others  Similar to conduct disorder (diagnosed in children; Axis I disorder)  Past terms used: moral insanity, psychopathic, psychopath  People with this disorder: deceitful with repeated lying to/conning of others for personal profit or pleasure o Commit violent criminal offences against others more often than those without the disorder: assault, murder, rape o Tend to have little remorse, indifferent to pain & suffering they’ve caused others  Poor control of impulses: low tolerance for frustration, no concern for the consequences of their behaviour o Often takes chances, seek thrills with no concern for danger o Easily bored, restless, unable to endure tedious routines, day-to-day responsibilities of marriage or job o Tend to drift from one relationship to another, in lower-status jobs, engage in criminal activity impulsively (50-80% in jail may be diagnosable with ASPD)  Psychopathy: broad personality traits vs. observable antisocial behaviours (in ASPD)  Cleckley/Hare criteria for psychopathy: o Superficial, grandiose sense of self-worth, tendency toward boredom, need for stimulation, pathological lying, ability to be cunning & manipulative, lack of remorse o Cold, callous, gain pleasure by competing with & humiliating others, cruel, malicious, insist on being seen as faultless, dogmatic in opinions o Can be gracious & cheerful in order to get what they want o Jailed vs. successful business people – successful psychopaths are better at maintain a normal outward appearance i.e. superior intelligence, put on mask of sanity Prevalence of Antisocial Personality Disorder  One of the most common personality disorders  Men more likely than women to be diagnosed  Bias? Clinicians more likely to see disorder in African Americans than in whites  Slightly more likely to have lower levels of education  80% abuse substances (drugs, alcohol), increased risk for suicide, violent death  Psychological/biological maturation: were not antisocial as children, but because antisocial as teens & adults Theories of Antisocial Personality Disorder Contributors  Genetic predisposition: twin studies 50% concordance rate in monozygotic twins o Theorized to be born with a number of genetically influenced deficits that put them at risk for developing ASPD  Testosterone: high levels associated with aggressiveness o Have role during prenatal development in organizing the fetal brain in ways that promote or inhibit aggressiveness  Serotonin: low levels contribute to impulsive & aggressive behaviours  Attention deficit hyperactivity disorder: develop antisocial behaviours in response to social rejection & punishment  Executive functions: deficits in brain involved in executive functions (planning & self monitoring) o Issues with ability to sustain concentration, abstract reasoning, concept & goal formation, ability to anticipate & plan, capacity to program & initiate purposive sequences of behaviour, self-monitoring, self awareness, ability to shift from maladaptive patterns of behaviour to more adaptive ones o May have structure or functioning deficits in temporal & frontal lobes tied to medical illnesses/exposure to toxins during infancy & childhood – might be genetic abnormalities  Arousability: low levels of arousability lead to fearlessness in dangerous situations, stimulating-seeking behaviour o Low heart rates, low skin conductance activity, excessive slow-wave electroencephalogram readings o Low levels of fear in response to threatening situations – useful for things like bomb disposal experts o Low arousal children may not fear punishment & cannot be deterred from antisocial behaviour o Low arousal leads to stimulation seeking behaviour – neutral (skydiving) or dangerous impulsive activities (robbery) o Children who are more intelligent experience more rewards in school & will make more positive stimulation seeking behaviour vs. less intelligent children who turn to deviant peer groups for gratification  Social cognitive factors: have parents who are harsh, neglectful, & child interprets situations in ways that promote aggression o Dodge & Pettit: integrative/comprehensives model of development of antisociality (p. 437) Treatments for Antisocial Personality Disorder  Tend to believe they do not need treatment  May submit to treatment due to marital discord, work conflicts, or incarceration but are prone to blaming other for their current situations & not accept responsibility of the situation  Clinicians don’t have much hope for effective treatment  Psychotherapy: help person gain control over his or her anger & impulsive behaviours by recognizing triggers & developing alternative coping strategies o Try to increased empathy for effects of behaviours on others  Lithium & other atypical antipsychotics: successfully control impulsive-aggressive behaviour  SSRIs for treatment of low serotonin although treatment efficacy not clear 2. Borderline Personality Disorder  Key features: rapidly shifting & unstable mood, self-concept, & interpersonal
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